The relationship between erythrocyte transfusion in very preterm infants and inflammatory cytokines and morbidities: a prospective observational study.

BACKGROUND

It is essential to assess not only the hematologic outcomes but also the immunologic and inflammatory consequences of RBC transfusion in preterm infants.

AIMS: This study aimed to evaluate changes in serum cytokine levels following red blood cell (RBC) transfusion in preterm infants born at ≤ 32 weeks of gestation and to assess their potential proinflammatory effects and associations with neonatal morbidities.

MATERIALS AND

METHODS

This prospective, single-center observational study included preterm infants born at ≤ 32 weeks of gestation, aged > 7 days, who received RBC transfusion. Serum interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), and melatonin were measured before and at 2 and 24 h after transfusion. Insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were analyzed at 1, 2, and 3 weeks post-transfusion.

RESULTS

Thirty-three infants met the inclusion criteria. The mean gestational age was 27.4 ± 2.7 weeks, and the mean birth weight was 1016 ± 356 g. Following transfusion, the hematocrit increased from 28.3 ± 3.1% to 35.0 ± 3.8%. No significant post-transfusion changes were observed in IL-1, IL-6, TNF-α, melatonin, or IGF-1 levels. However, VEGF increased (p = 0.045) and IGFBP-3 decreased (p = 0.022) significantly. During follow-up, clinical sepsis was observed in 7 (21.2%), 4 (12.1%), and 1 (3.0%) infants at weeks 1, 2, and 3, respectively (p = 0.007). Respiratory support requirements decreased over time, particularly for non-invasive synchronized intermittent mandatory ventilation (p = 0.029).

CONCLUSIONS

In this single-arm observational cohort, RBC transfusion was followed by increased VEGF and decreased IGFBP-3 levels, without significant changes in major proinflammatory cytokines. During follow-up, respiratory support requirements decreased and clinical sepsis was observed in a subset of infants. However, because no non-transfused control group was included, these clinical findings should be interpreted as descriptive and exploratory temporal observations rather than evidence of causality.